Objective To investigate clinicopathologic features, pathogenesis, and diagnosis and treatment of hereditary pancreatitis (HP). Method The relevant literatures on HP research in recent years were searched and reviewed. Results The HP was similar to the pancreatitis caused by the cholelithiasis, excessive alcohol consumption, hyperlipidemia, etc. in the histomorphology, function, and clinical manifestations and it was difficult to be distinguished. However, HP was different from the other types of chronic pancreatitis due to its early onset, familial, and high risk of pancreatic cancer. The HP was mainly caused by the PRSS1 mutations, and its mutation types mainly included the R122H, N29I, A16V, K23R, etc., among which the R122H and N29I were the two most common types of mutations. There was no specific treatment for the HP. The principles of treatment of HP were similar to the pancreatitist caused by other etiologies, including the nutritional support, blood sugar control, analgesia, etc.. In addition to the medical treatment, the surgical intervention was also the important means for the treatment of HP, including the pancreatic partial resection, total pancreatectomy or total pancreatectomy combined with islet cell autografting. Conclusions HP is an autosomal dominant hereditary disease characterized by recurrent attacks of pancreatitis. Relevant gene tests could be performed for patient with highly suspected HP. It faces great challenges in treatment of HP. Pathogenesis of HP needs to be constantly explored and experimental study of multicenter and large sample needs to be further studied in order to determine its best treatment strategy.
Objective To study effects of Helicobacter pylori on oncogenesis and progression of pancreatic cancer. Method The current literatures on the relationship between the Helicobacter pylori and the pancreatic cancer were collected and reviewed. Results The Helicobacter pylori infection might play a role in the development of the pancreatic cancer. The infection rate of the Helicobacter pylori in the patients with pancreatic cancer is higher than that of the healthy controls; furthermore, in the patients with Helicobacter pylori antibody positive, the infection rate of the Helicobacter pylori in the cytotoxin-associated gene A-negative strains of Helicobacter pylori is significantly higher than that of the healthy controls. Conclusions Helicobacter pylori infection is related to occurrence and development of pancreatic cancer. Specific mechanism is still not clarified and further research is need to study.
The course of chronic pancreatitis is prolonged, and pain is the main symptom, which seriously affects the quality of life and work ability of patients. Its treatment is the most important and complex problem. This article systematically describes the theoretical basis, indications, efficacy, selection and balance of drugs, endoscopy, surgery and other measures related to pain treatment.
ObjectiveTo analyze risk factors of intraoperative massive hemorrhage in patients with pancreatitis-induced sinistral portal hypertension (SPH) and to explore its strategies of treatment.MethodsThe clinical data of patients with pancreatitis-induced SPH admitted to the West China Hospital of Sichuan University from January 2015 to March 2018 were retrospectively analyzed. The intraoperative massive hemorrhage was defined as the blood loss exceeding 30% blood volume. The factors closely associated with the intraoperative massive hemorrhage were analyzed by the forward logistic regression model.ResultsA total of 128 patients with pancreatitis-induced SPH were enrolled in this study, including 104 males and 24 females, with an average age of 47 years old and a median intraoperative bleeding volume of 482 mL. Among them, 93 patients with pancreatitis-induced SPH caused by the pancreatic pseudocyst after acute pancreatitis and 35 caused by the chronic pancreatitis. There were 36 patients with history of upper gastrointestinal bleeding and 46 patients with hypersplenism. Thirty-six patients suffered from the massive hemorrhage. Among them, 30 patients underwent the distal pancreatectomy concomitant with splenectomy, 1 patient underwent the duodenum- preserving resection of pancreatic head, and 5 patients underwent the pseudocyst drainage. The univariate analysis showed that the occurrence of intraoperative massive hemorrhage in the patients with pancreatitis-induced SPH was not associated with the gender, age, body mass index, albumin level, upper gastrointestinal bleeding, hypersplenism, type of pancreatitis, course of pancreatitis, number of attacks of pancreatitis, size of spleen, maximum diameter of lesions in the splenic vein obstruction site, or number of operation (P>0.05), which was associated with the diameter of varicose vein more than 5.0 mm (χ2=19.83, P<0.01), the intraperitoneal varices regions (χ2=13.67, P<0.01), the location of splenic vein obstruction (χ2=5.17, P=0.03), the operation time (t=–3.10, P<0.01), or the splenectomy (χ2=17.46, P<0.01). Further the logistic regression analysis showed that the varicose vein diameter more than 5.0 mm (OR=6.356, P=0.002) and splenectomy (OR=4.297, P=0.005) were the independent risk factors for the intraoperative massive hemorrhage in the patients with pancreatitis-induced SPH.ConclusionsSplenectomy and having a collateral vein more than 5.0 mm in diameter are independent risk factors for intraoperative massive blood loss in surgeries taken on patients with pancreatitis-induced SPH. Attention should be paid to dilation of gastric varices and choice of splenectomy.
Objective To summarize current research advances of mechanism and treatment of pancreatic endocrine and exocrine insufficiency in chronic pancreatitis. Method The related literatures about the research progress of the pancreatic endocrine and exocrine insufficiency in the chronic pancreatitis in recent years were retrieved and reviewed. Results In recent years, it had many new studies and discoveries on the pancreatic endocrine and exocrine insufficiency in the chronic pancreatitis. The mechanism of the pancreatic exocrine dysfunction was mainly due to the decrease of the pancreatin secretion in the patients with chronic pancreatitis. The mechanism of the pancreatic endocrine insufficiency was mainly due to the damage of the pancreatic exocrine gland and islet tissue in the chronic pancreas, which leaded to the destruction of the pancreatic endocrine cells, the other endocrine cells, and the disturbance of the intestine-islet axis, followed by the disorder of the various hormones (insulin, glucagon, pancreatic polypeptide, etc.), and eventually manifested the glucose tolerance or dominant diabetes. Conclusions At present, although there is a certain degree understanding for pancreatic endocrine and exocrine insufficiency in chronic pancreatitis, there are no breakthroughs in its mechanism and treatment, and effect is lack of large sample and multicenter clinical control study. Exploring more optimized detection methods and establishing a perfect treatment system is goal of future development and research.
慢性胰腺炎是胰腺進行性炎癥性疾病，以胰腺實質持續性破壞和纖維化等不可逆性的形態改變為其特征，并引起頑固性疼痛和(或)永久性功能喪失。迄今，其發病機理、病理生理和疾病過程仍不十分清楚，各種治療也僅限于疾病的并發癥。
Objective To explore changes and challenges on management of chronic pancreatitis. Methods The updated clinical guidelines and the latest research findings were collected and reviewed. Results The proposition of a new mechanistic definition and identification of an early stage give us a novel insight into chronic pancreatitis. The intraductal pancreatic calcifications has been regarded as the most reliable ultrasonography and CT features of chronic pancreatitis. In addition, the endoscopic ultrasonography is also of great value. The present surgical strategies are established on the concepts of step-up approach and damage control. The surgery perform better than the endoscopic treatment in the long-term outcome, but the timing course of surgery need to be further investigated. Conclusions Early diagnosis and treatment plays a critical role in cases of chronic pancreatitis. More patients of chronic pancreatitis should be treated in a multidisciplinary team as future perspectives.